Summary 4.1 Addiction lecture notes

ADDICTION LECTURE 1
- all addictions have the same mechanisms more or less
- Addiction is comorbid with many other disorders (scz, depression, anxiety etc.)
- top 3 disorders in NL:
o mood disorders (20.2%)
o anxiety (19.6%)
o substance disorder (19.1%) (1/5 people)
- not a lot of gender differences but addiction is mainly a male problem (only in
prescription drug addiction there’s more female)
- societal relevance:
o impact on health
o relationship with crime (>50% substance related)
o impact on public safety
o impact on work-related productivity
- not everyone will get addicted after using smt once, cigarettes are the most
addictive, but it’s also more available
- DSM 5 criteria for substance use
o 2 of the symptoms out of the 11:
 taking the substance in larger amounts and for longer than meant to
 wanting to stop, but not able to
 spending a lot of time getting, using or recovering from use
 cravings to use the substance
 not managing responsibilities at work, home or school bc of substance
use
 continuing use even when it causes problems in relationships
 giving up important social, occupational or recreational activities bc of
use
 using substances again, even when it puts you in danger
 continuing to use even when you know you have a physical or
psychology problem caused or made worse by the substance
 needing more of the substance to get the effect you want (tolerance)
 developing withdrawal symptoms, relived by taking the substance
o tolerance and withdrawal – you don’t need to have these to be diagnosed
o craving added to dsm 5, it wasn’t in dsm 4
o “legal problems” criterion was taken out from dsm 5
- types of substances:
o tobacco (cigarettes)
o stimulants (cocaine, amphetamines, XTC)
o depressants (alcohol, benzodiazepines, GBH)
o opioids (heroin, prescription drugs)
o hallucinogens (cannabis, LSD, ketamine)
- neurotransmitters (chemical substance providing communication between cells)
o agonists: mimics the effects of neurotransmitters by binding to the same
receptor and produce the same effect
o antagonists: bind to the same receptor and block and prevent the functional
effects

, o cocaine: inhibits reuptake of dopamine, dopamine agonist (more dopamine in
the cleft)
o XTC (MDMA): increases serotonin (and dopamine) in cleft, increases release,
reduces reuptake
o alcohol: less understood, all systems influenced (GABA agonist, NMDA
antagonist, opioid agonist, serotonin agonist)
o https://drugsindehersenen.jellinek.nl/en/
- Number 1 killer: tobacco (by far), then alcohol then opioids, worse image then
actuality
- Pain killer problem in the US (codeine, oxycodone, methadone, morphine, fentanyl)

,LECTURE 2
Substance use and desire
- desire: definition of a high motivational state
- 2 types of desire:
o volitive desire: rational, more long term
o appetitive desire: makes you and want and crave something, more bodily
(what we talk in the literature)
 forbidden fruits, sex, alcohol, drugs, unhealthy food
 attracts attention
 in psychopathology: it can be higher (like craving) or lowered (like in
apathy/anhedonia)
 everyone experiences appetitive desire (e.g. being in love), but not
excessive levels
 can be excessive and psychiatric levels (food, sex, psychoactive
substances)

Two key concepts:
- craving: subjective desire to experience the effects of a previously used drug
- relapse: full resumption of drug-seeking and drug-administration behavior after a
period of abstinence (this is debatable  other literature also talks about different
definitions of relapse and abstinence)
o relapse after detoxification are high (50-80%)
o relapse rates are high for all substances
o relapse often preceded by craving
o detoxification is not the problem but craving is the most reported reason for
relapse

Causes of craving and relapse:
- 1. priming effect (just a small sip or puff)
o priming dose triggers craving and relapse
- 2. emotional stress (negative reinforcement)
o increase alcohol/drug craving
o very important in treatment
- 3. exposure to drug-related stimuli (pavlovian/classic conditioning)
o e.g. context
o addiction is a learning behavior
o should drug addiction be viewed as a learning
disorder? coordinator things yes

Operant (instrumental) conditioning:
o drugs and alcohol can be both positive and
negative reinforcement
o you like the taste or feeling of a cigarette, you
smoke (positive reinforcement), behavior
increases

, o taking away the stimuli, as an alcoholic you have a hangover, so you drink
more to get rid of it (behavior increases), it becomes a negative
reinforcement
 hangover, withdrawal, stress, pain  they drink to get rid of these
o operant conditioning cannot explain addiction, not everyone who uses
painkillers to relieve pain get addicted to it

Classical conditioning:
- when you use drugs for a long time then classical conditioning kicks in
- certain context every time you smoke a cigarette or drink alcohol, can be an
emotional state too (feeling upset)
- repeated pairings of particular events, emotional states, or cues (money, places,
people, time of the day) with substance use produce craving for that substance
- eventually exposure to cues alone produces drug or alcohol cravings and urges often
followed by substance use
o instrumental conditioning is more
in the beginning (effect of the
substance itself)
o then classical conditioning over
time (context)

Experiment by Robins (1975): role of context
- US Vietnam soldiers used heroin (34%) and
20% were dependent
- in the first year after returning to the US
only 1% became re-addicted
o strong effect of context, not being in Vietnam in war

Some other related phenomena
Conditioned withdrawal
- when you go to a conditioned location (e.g. where you used the drug), you start
getting withdrawal effects (sweating etc.)
- the urge to use drugs is also bigger because of the conditioned withdrawal
Drug opposite CR (conditioned response)
- negative effects of withdrawal
- when you use drug, you feel warm, drug opposite CR would be feeling cold
Conditioned tolerance
- your body prepares itself before taking drug or alcohol (body produces compensatory
responses)
- in a different location you would overdose with 2 doses
- but in your regular regulation you wouldn’t overdose with 2 doses
- “diminishment or loss of drug effect over the course of repeated administrations”

Social learning:
- modeling (friends etc.)
- self-efficacy (confidence you have about stopping)